Individual provider Active NPI

Holly O'Brien, LCSW

  • Clinical Social Worker
  • Clay City, IL
National Provider Identifier
1598575680
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.012860 Issued in IL
Practice address
939 Sunset Rd SW
Clay City, IL 62824-1113
Phone
(618) 662-2131
NPI assigned
Jan 10, 2025
Last updated
Jan 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.012860 IL Primary

Addresses

Primary practice location

939 Sunset Rd SW
Clay City, IL 62824-1113

Mailing address

1920 E Heart Grove LN
Dundas, IL 62425-2214
Phone (618) 843-5932

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250417002467 IL Practitioner - Clinical Social Worker 1658896030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of ClayGroup PAC ID 0042101982, 77 clinicians

Practice addresses (Care Compare)

939 Sunset Rd SW
Clay City, IL 62824-1113
Phone (618) 662-2191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.012860ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Clay Current Accepting new patients
County of Clay CurrentSince Mar 8, 2025 Accepting new patients
County of Clay CurrentSince Mar 8, 2025 Accepting new patients
County of Clay Past Accepting new patients

Locations

939 Sunset Rd SW
Clay City, IL 62824
Phone (686) 662-2131

911 Stacey Burk Dr
Flora, IL 62839
Phone (618) 662-2161

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1598575680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 E HEART GROVE LN",
            "city": "DUNDAS",
            "state": "IL",
            "postal_code": "624252214",
            "telephone_number": "618-843-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 SUNSET RD SW",
            "city": "CLAY CITY",
            "state": "IL",
            "postal_code": "628241113",
            "telephone_number": "618-662-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "HOLLY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-10",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.012860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clay City, IL

Sources for this page

Verify at the official NPI Registry.